A Viewpoint on Evidence-based Health Informatics,Based on a Pilot Survey on Evaluation Studies in Health Care Informatics

Concerned about evidence-based health informatics, the authors conducted a limited pilot survey attempting to determine how many IT evaluation studies in health care are never published, and why. A survey distributed to 722 academics had a low response rate, with 136 respondents giving instructive comments on 217 evaluation studies. Of those studies, half were published in international journals, and more than one-third were never published. Reasons for not publishing (with multiple reasons per study possible) included: “results not of interest for others” (1/3 of all studies), “publication in preparation” (1/3), “no time for publication” (1/5), “limited scientific quality of study” (1/6), “political or legal reasons” (1/7), and “study only conducted for internal use” (1/8). Those reasons for non-publication in health informatics resembled those reported in other fields. Publication bias (preference for positive studies) did not appear to be a major issue. The authors believe that widespread application of guidelines in conducting health informatics evaluation studies and utilization of a registry for evaluation study results could improve the evidence base of the field.     

Pathological States and Criminal Responsibility

The doctor is embarrassed in court when asked to testify to the effects of illness on a defendant's capability “of appreciating the nature and quality of an act or omission or of knowing that an act or omission is wrong”. The source of his difficulty is traced to the legal concepts of “guilt”, “crime” and “punishment” which imply a legal view of man at variance with our modern biological view. To abolish this discrepancy we need not accept a medical model for criminal law where “crime” is analogous to “disease”, and “punishment” to “treatment”. A pragmatic approach to the handling of the criminal could exclude the notions of “guilt” and “punishment” and yet fulfil the rational goals of protecting society from the criminal and of compensating his victims.     

《军医进修学院学报》进入"RCCSE中国核心学术期刊"的启示

<军医进修学院学报>从组稿、加大载文量和基金课题来稿量、缩短刊稿周期、积极加入国外知名检索数据库等方面着手,迅速提高期刊被引频次和影响因子,于2011年4月被<中国学术期刊评价研究报告2010-2011>评为"RCCSE(Research Center for Chinese Science Evaluation)中国核心学术期刊(A)".本次评价共计进入核心区被评为A+和A的优秀期刊为1 273种,占我国学术期刊总数(6 400种)的19.89%,其中,<军医进修学院学报>分别位列我国126种高校学报第19位(前15%)和194种医学综合学术期刊第20位(前10%),前者为首次进入优秀期刊排名,后者较上一评价提高了39个名次.     

A systems approach to accepted standards of care: Shifting the blame

In healthcare, from a legal perspective, the standard of acceptable practice has been generally set by the courts and defined as healthcare professionals acting in a manner that is widely accepted by their peers as meeting an acceptable standard of care. This view, however, reflects the state of how practice “is” rather than what it “ought to be”. What is ought to be depends on whether you take a “person” or “system” oriented approach to practice.The increasing pressures of lack of money and resources, and an ever–increasing need for care are bringing pressure on the health services to move to a system approach and this is gaining acceptance both with clinicians and thus eventually the courts.A systems-type approach to healthcare will, by necessity, embrace clinical protocols and guidelines supported by clinical information systems. It will also see blame for errors shifting from clinicians to the organisations that employ them.This paper argues that a continued use of a person-based approach to healthcare, developed through an historical record of practice by individual clinicians, is no longer adequate defence in a case of supposed negligence.When the healthcare system has codified clinical guidelines and digital data gathered across thousands of clinicians and their patients, it is possible to compute adequate levels of care and expect clinicians and the healthcare system in general to meet these minimum standards.Future negligence decisions will rely on a systems-based best practice standard of care determined through evidence rather than opinion     

广东省医学期刊网站建设情况调查分析

目的 探讨广东省医学期刊的网络化发展的现状及趋势。方法 对国内外几种著名医学科技期刊数据库系统以及网络通用搜索引擎进行检索,调查分析了广东省医学期刊的网站建设情况,并对广东省生物医学核心期刊网站建设情况进行了电话咨询与核实。结果 我省印刷版医学期刊实现网络化主要通过3种途径来完成,即利用主办单位网站或权威性科技网站以及建立独立网站。结论 近几年我省网上医学期刊有了较大发展,通过中国期刊网,万方数据资源系统均可提供全文检索。不过,网络出版一般晚于纸版印刷,且独立网站建设尚未形成规模。其中《第一军医大学学报》、《癌症》被IM收录并完成了与PubMed之间的全文链接,其网络版摘要先于印刷版。     

The Metabolism of the Volatile Amines: III. A Microaeration Technique for the Measurement of the Two Components of the Blood Ammonia Level

A microaeration technique for the measurement of the ammonia content of blood is described by means of which the amount of ammonia present in blood (“free” ammonia) can be differentiated from that which is liberated during the testing procedure by deamidating action of the alkali reagents employed. Blood is mixed with saturated potassium carbonate solution in the microaeration chamber (a bent 10-ml. pipette) and a stream of nitrogen carries the released ammonia into a collecting acid where the total ammonia liberated can be estimated at frequent intervals.

A blood ammonia diffusion curve can be drawn by plotting the total ammonia diffused against the microaeration time. This is a composite curve in that it consists of the sum of an exponential curve which corresponds to the diffusion of “free” ammonia, and a relatively straight line which corresponds to the formation of ammonia by the breakdown of blood constituents. By extrapolating the linear segment back to the ordinate the quantity of ammonia initially present in the blood can be estimated. This technique is easy to learn, requires inexpensive equipment and small volumes of blood, and gives reproducible results.

     

广东省医学期刊网站建设情况调查分析

目的 探讨广东省医学期刊的网络化发展的现状及趋势。方法对国内外几种著名医学科技期刊数据库系统以及网络通用搜索引擎进行检索，调查分析了广东省医学期刊的网站建设情况，并对广东省生物医学核心期刊网站建设情况进行了电话咨询与核实。结果我省印刷版医学期刊实现网络化主要通过3种途径来完成，即利用主办单位网站或权威性科技网站以及建立独立网站。结论近几年我省网上医学期刊有了较大发展，通过中国期刊网，万方数据资源系统均可提供全文检索。不过，网络出版一般晚于纸版印刷，且独立网站建设尚未形成规模。其中《第一军医大学学报》、《癌症》被IM收录并完成了与PubMed之间的全文链接，其网络版摘要先于印刷版。     

Neurological Factors in Reading Disability

An overview is presented of that portion of the literature on reading disability wherein neurological defect is seen as causal or correlative. From the publication of Hinshelwood's “Congenital Word Blindness” (1917) to the present, investigators have considered the possible association of reading difficulty with genetically determined neurological defect, with cerebral damage, with biochemical imbalance inhibiting synaptic transmission, and with some form of maturational lag.     

Problems Related to the Use of Food Additives in the United States

Major problems encountered by enforcement agencies and by regulated industries, respectively, in implementing and conforming to recent food additive laws are reviewed. Decisions as to which substances fall within the broad terms of the legal definition, and which escape by virtue of “generally recognized as safe” (GRAS) status, are often difficult and complex. Distinctions cannot be made solely on the basis of whether substances are old or new, natural or synthetic. Registration of pesticides on a “no residue” basis and establishment of “zero tolerances” for food additives have created an anomalous situation as a result of improvements in sensitivity of analytical techniques which revealed the presence of minute amounts of substances where none were believed to exist. A solution has been recommended by a specially appointed committee of the National Academy of Sciences-National Research Council (U.S.A.). Enforcement of the new food additive laws warrants revision of present labelling requirements to provide for designating chemical ingredients by functional categories rather than by confusing chemical terminology.     

J Wave Syndromes: A Decade of Progress

Objective:

The objective was to provide a brief history of J wave syndromes and to summarize our current understanding of their molecular, ionic, cellular mechanisms, and clinical features. We will also discuss the existing debates and further direction in basic and clinical research for J wave syndromes.

Data Sources:

The publications on key words of “J wave syndromes”, “early repolarization syndrome (ERS)”, “Brugada syndrome (BrS)” and “ST-segment elevation myocardial infarction (STEMI)” were comprehensively reviewed through search of the PubMed literatures without restriction on the publication date.

Study Selection:

Original articles, reviews and other literatures concerning J wave syndromes, ERS, BrS and STEMI were selected.

Results:

J wave syndromes were firstly defined by Yan et al. in a Chinese journal a decade ago, which represent a spectrum of variable phenotypes characterized by appearance of prominent electrocardiographic J wave including ERS, BrS and ventricular fibrillation (VF) associated with hypothermia and acute STEMI. J wave syndromes can be inherited or acquired and are mechanistically linked to amplification of the transient outward current (I_to)-mediated J waves that can lead to phase 2 reentry capable of initiating VF.

Conclusions:

J wave syndromes are a group of newly highlighted clinical entities that share similar molecular, ionic and cellular mechanism and marked by amplified J wave on the electrocardiogram and a risk of VF. The clinical challenge ahead is to identify the patients with J wave syndromes who are at risk for sudden cardiac death and determine the alternative therapeutic strategies to reduce mortality.     

Applicants to Canadian Medical Schools for 1966-67

An examination of applicants to Canadian medical schools for 1966-67 revealed that 4534 applications were received for the approximately 974 available places. The number of Canadian applications was 2866 and these were made by 1815 individual applicants, an increase of 48 over 1965-66. United States applicants declined from 1143 to 1013.

Evaluations made by the schools concerning the acceptability of the Canadian applicants disclosed that 55 applicants who rated as “acceptable” by one or more schools failed to gain admission to any medical school in 1966-67 (as compared to 36 in 1965-66). However, of those applicants who did find a place 76 were evaluated as “marginal” or “unacceptable”, while another 126 were rated as “acceptable” by one school but “marginal” and/or “acceptable” by one or more other schools.

These results were interpreted to imply that the Canadian medical schools were still experiencing difficulty in attracting well-qualified applicants for study in medicine.

     

Alternative medicine and doping in sports

Athletes are high achievers who may seek creative or unconventional methods to improve performance. The literature indicates that athletes are among the heaviest users of complementary and alternative medicine (CAM) and thus may pioneer population trends in CAM use. Unlike non-athletes, athletes may use CAM not just for prevention, treatment or rehabilitation from illness or injuries, but also for performance enhancement. Assuming that athletes'' creative use of anything unconventional is aimed at “legally” improving performance, CAM may be used because it is perceived as more “natural” and erroneously assumed as not potentially doping. This failure to recognise CAMs as pharmacological agents puts athletes at risk of inadvertent doping.The general position of the World Anti-Doping Authority (WADA) is one of strict liability, an application of the legal proposition that ignorance is no excuse and the ultimate responsibility is on the athlete to ensure at all times whatever is swallowed, injected or applied to the athlete is both safe and legal for use. This means that a violation occurs whether or not the athlete intentionally or unintentionally, knowingly or unknowingly, used a prohibited substance/method or was negligent or otherwise at fault. Athletes are therefore expected to understand not only what is prohibited, but also what might potentially cause an inadvertent doping violation. Yet, as will be discussed, athlete knowledge on doping is deficient and WADA itself sometimes changes its position on prohibited methods or substances. The situation is further confounded by the conflicting stance of anti-doping experts in the media. These highly publicised disagreements may further portray inconsistencies in anti-doping guidelines and suggest to athletes that what is considered doping is dependent on the dominant political zeitgeist. Taken together, athletes may believe that unless a specific and explicit ruling is made, guidelines are open to interpretation. Therefore doping risk-taking behaviours may occur because of the potential financial, social and performance gains and the optimistically biased interpretation (that trying alternatives is part of the “spirit of sport”) and doping risk-taking behaviours may occur.This discussion paper seeks to situate the reader in a world where elite level sports and CAM intersects. It posits that an understanding of the underlying motivation for CAM use and doping is currently lacking and that anti-doping rules need to be repositioned in the context of the emerging phenomenon and prevalence of CAM use.     

A pilot study to evaluate the diagnostic accuracy of local terminology for malaria screening among children in rural Malawi

Background

Malaria is a serious health problem in Malawi. It is responsible for 43% of all out patient visits and 19% of all deaths occurring to children under five years of age. Rapid diagnosis and appropriate treatment can avert most malaria deaths. However this is not always possible in resource limited settings where functioning laboratories are almost nonexistent.

Methods

This paper assesses the accuracy of local terminology in detecting parasitemia in children using blood smears as the reference standard.

Results

The study observes that there are local terms that can be used as an inexpensive, readily available and easily implementable malaria screening test in Malawian children in rural areas. These terms include “malungo” (official name for malaria), “kutentha thupi” (hot body), “kutsegula m''mimba” (official term for diarrhoea) and “kukhosomola” (coughing). The local terms “malungo” and “kutentha thupi” yielded better results.

Conclusion

Although the local terminology produced results that are less than optimal, the study concludes that the knowledge of sensitivity and specificity of local terminology can be used by local healthcare practitioners to identify children who could benefit from malaria confirmation testing and presumptive treatment. The study, however, cautions that these terms should be used as an entry point to malaria case management as they do not distinguish the severity of the malaria infection and all of them produced a sensitivity of less than 50%.     

Development and Application of a Framework for Maintenance of Medical Terminological Systems

Objective

Terminological Systems (TSs) need to be maintained in order to sustain their utility. This paper describes a study aiming at the standardization of the maintenance processes of medical TSs by capturing the criteria for the management of the maintenance processes into a framework. Furthermore, this paper describes application of the framework, which sheds light on the current practice of TS maintenance.

Design

Observational study.

Measurements

By means of a literature study, criteria for the maintenance of TSs were obtained and categorized into a framework. The current practice of TS maintenance was explored by a survey among organizations that maintain a TS. Results were stratified by the size of the TS being maintained.

Results

From Sixty-three relevant articles, criteria for the maintenance processes of TSs were extracted and organized into four components. The primary component “Execution” concerns the core activities of the maintenance process. The other three components “Process management,” “Change specifications,” and “Editing tools” support the core activities of the component “Execution.”The survey had a response rate of 40% (37 of 93). The answers reflect the large variation in the number of criteria that are satisfied for the participating organizations. Overall, maintenance of larger TSs seems to satisfy more criteria.

Conclusions

The framework is an important step towards standardization of the maintenance of medical TSs and can be used to eliminate shortcomings in this process. Surveying the current practice showed that there is ample room to improve the maintenance processes of medical TSs, especially for the smaller TSs.     

Trends in biomedical informatics: automated topic analysis of JAMIA articles

Biomedical Informatics is a growing interdisciplinary field in which research topics and citation trends have been evolving rapidly in recent years. To analyze these data in a fast, reproducible manner, automation of certain processes is needed. JAMIA is a “generalist” journal for biomedical informatics. Its articles reflect the wide range of topics in informatics. In this study, we retrieved Medical Subject Headings (MeSH) terms and citations of JAMIA articles published between 2009 and 2014. We use tensors (i.e., multidimensional arrays) to represent the interaction among topics, time and citations, and applied tensor decomposition to automate the analysis. The trends represented by tensors were then carefully interpreted and the results were compared with previous findings based on manual topic analysis. A list of most cited JAMIA articles, their topics, and publication trends over recent years is presented. The analyses confirmed previous studies and showed that, from 2012 to 2014, the number of articles related to MeSH terms Methods, Organization & Administration, and Algorithms increased significantly both in number of publications and citations. Citation trends varied widely by topic, with Natural Language Processing having a large number of citations in particular years, and Medical Record Systems, Computerized remaining a very popular topic in all years.     

Insulin Neuroprotection and the Mechanisms

Objective:

To analyze the mechanism of neuroprotection of insulin and which blood glucose range was benefit for insulin exerting neuroprotective action.

Data Sources:

The study is based on the data from PubMed.

Study Selection:

Articles were selected with the search terms “insulin”, “blood glucose”, “neuroprotection”, “brain”, “glycogen”, “cerebral ischemia”, “neuronal necrosis”, “glutamate”, “γ-aminobutyric acid”.

Results:

Insulin has neuroprotection. The mechanisms include the regulation of neurotransmitter, promoting glycogen synthesis, and inhibition of neuronal necrosis and apoptosis. Insulin could play its role in neuroprotection by avoiding hypoglycemia and hyperglycemia.

Conclusions:

Intermittent and long-term infusion insulin may be a benefit for patients with ischemic brain damage at blood glucose 6–9 mmol/L.     

Long-Stay Patients in Canadian Mental Hospitals, 1955-1963

Changes in the number and characteristics of patients in Canadian mental hospitals during 1955-1963 were studied in order to assess the future need for long-term hospital care.

Despite marked increases in the number of first admissions and readmissions, the average number of patients in hospital decreased 6% from 49,537 in 1955 to 46,498 in 1963.

Patients who were “long stay” in 1955 continued to leave hospital at the same rate during the years 1960-1963 as during 1955-1959. No “hard core” of long-stay patients with reduced potential for discharge seemed to have formed by 1963.

Since 1955 the number of “admissions” remaining continuously hospitalized has progressively decreased for the elderly and for patients with psychoses. No build-up of new long-stay patients from patients with repeated short admissions was evident.

The estimate of the Royal Commission on Health Services that the ratio of patients in mental hospitals could be reduced from 3.0 per 1000 in 1961 to 1.5 per 1000 by 1971 seems feasible.

     

Psychological Aspects of Headache

Headache is considered as a non-specific syndrome illustrating the concept of pain as an emotion. Viewed in this way, its meaning looms larger than its site.

Pain indicates dis-ease of the patient, sometimes with his body, but more often with his life. No pain is “imaginary”, nor can some pain be assigned to physiological and some to psychological pathways. Such a decision is often merely a judgmental one.

Just as the “brain” cannot easily be separated from the “mind”, so to believe that some pain is “physical” and some “emotional” is a distortion. All painful syndromes are mixed and the problem is to decipher the meaning of the pain. Only rarely will headache respond to physical measures alone.

     

Predictors associated with the mental health of Japanese male registered nurses: focusing on environments with many female registered nurses and female patients’ refusal to accept nursing services from male registered nurses

Objective: To study the improvement of the mental health of Japanese male registered nurses, we investigated the predictors associated with the Japanese version of the 12-item General Health Questionnaire (GHQ-12). For those predictors, we focused on environments with many female registered nurses and female patients’ refusal to accept nursing services from male registered nurses.Materials and Methods: This study was conducted in 93 hospitals in the Aichi, Gifu, and Mie prefectures of Japan. The analyzed subjects were 1,216 full-time male registered nurses. The average age (standard deviation) was 34.5 (9.2) years. Multiple logistic regression analysis was conducted. A GHQ-12 score of ≤3 indicated good mental health, and a score of ≥4 indicated poor mental health. “Mental health” was a dependent variable. The independent variables were: “Age”, “Male registered nurses as important partners on the job”, “Female registered nurses’ good manners toward male registered nurses”, “Fairness regarding male registered nurses’ promotions”, and “Female patients’ refusal to accept nursing services from male registered nurses”.Results: There were 728 (59.9%) full-time male registered nurses with good mental health and 488 (40.1%) with poor mental health. The mental health of the male registered nurses who had negative feelings regarding, “Male registered nurses as important partners on the job” was significantly worse, and that of those who had negative feelings regarding, “Female registered nurses’ good manners toward male registered nurses” was also significantly worse.Conclusion: Female registered nurses must recognize that their attitudes toward male registered nurses influence the mental health of male registered nurses. Hospital managers should provide male registered nurses who cannot establish appropriate relations with female registered nurses with consultation opportunities. Such organizational action by managers is necessary.